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3 APTO 1 (1959)

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The   Journal of the Association for Psychiatric Treatment of Offenders    [

                               February, 1959, Vol. 3 No.1


The Treatment Philosophy

of   APTO

       MELITTA SCHMIDEBERG. M.D.

   Psychotherapy  of offendrs should be regarded
as  a  distinct sub-specialty, requiring special
technics which   differ from  those  of general
psychotherapy.  Out-patient  psychotherapy,  as
usually practiced today, is so much geared to the
neurotic patient that, even when its methods are
modified, it is still unsuited for most offenders,
who  in essential points represent the opposite of
the  neurotic. On the other  hand, institutional
treatment  of criminals has  unavoidably  severe
drawbacks  because of the artificiality of the treat-
ment  environment. Since the offender should be
treated whenever  possible under the temptations
and  stresses of normal life with which  he has
hitherto failed to cope, i.e., as out-patients, we
must  therefore develop new technics and a new
treatment  philosophy. Most  offenders have  no
real wish to change, and they submit to therapy
only  under direct or indirect pressure. Psycho-
therapists, as a rule, do not like to treat patients
who   are  not  genuinely motivated.  However,
psychotherapy   will fail to make   an essential
contribution to social problems unless and until
it undertakes to handle this special type of patient.
    Treatment of offenders should be community-
 oriented rather than therapist-oriented. Treatment
 of neurotics is based on the fiction of an idealined
 patient-doctor relation which, even for neurotics,
 only occasionally holds true. This fiction is based
 on two  assumptions: that the patient is frank,
 cooperative, ready to make sacrifices and anxious
 to change and that the benevolent therapist helps
 him by expressing sympathy  and encouragement.
 Since the first premise does not apply to offenders,
 it is doubtful that the second applies either.
    APTO's   treatment philosophy  is  based on
 close cooperation with the courts and probation
 and parole services.Our therapists accept the un-
 flattering fact that the patients usually see them
 initially only as an alternative to prison. This is
 the same reason that the offender visits the proba-
 tion officer. Like the latter, our therapists try to
 convert this enforced relation into a genuine one,
 which can then be utilized to socialize the patient.
 Success in therapy  depends  upon  making  this
 conversion. More  important than the technic of
 the therapist is his attitude; he must feel that by
 socializing the offender he is doing something
 positive for, and not against, his patient, and that
 by inculcating social values and developing self-
 control and responsibility he is turning outcasts
 into acceptable and accepted members of society.
 The patient must learn that the fact that he has
 been wvronged as a child or later does not justify
 his breaking the law and that knowing the causes


for his behavior does not justify it. Indiscriminate
encouragement  is dangerous, as are indiscriminate
analytic interpretations. We must be guided  by
definite social values and clinical goals.
   APTO   cooperates closely with the courts, but
we  arc not employed  by them. The  patients re-
ferred by the courts are seen either in the offices
of the association or more often in the private
office of the therapist. The latter feature of our
treatment plan in itself has a socializing value.
We  provide diagnostic reports to the courts, keep
in close contact with the probation officer during
treatment and give, upon request, progress reports.
This can  be done without  harming- the patient,
and  the cooperation with  the probation officer
and  the information  we  receive from him  are
invaluable. Motivation and constant remotivation
of the patient, first by the probation officer, then
by the intake psychiatrist, and again and again by
the therapist, is an essential aspect of treatment.
   Our  staff consists at present qf a  Clinical
Director, the three members of the multidisciplin-
ary Intake Staff, fourteen therapists, several testing
psychologists, social workers  and  reading in-
structors. These personnel see the patient for a
token  fee or without  charge.  Most  therapists
prefer to handle the family as well. In some cases,
we  have found it useful for more than one therapist
to have contact with the patient. Generally we do
not regard therapy us a one-to-one relation taking
place within the confines of the therapist's office,
but rather a broader process involving the entire
community.  That  the patient has to learn to get
along with  his probation officer, to stop his law-
breaking activities, to take a steady job, and soon,
are  not only  practical necessities but steps in
therapy towards  the goal of socialization.


Special Difficulties In                  -

Working With Adolescent

Offenders (Part I)

           RUTH OCHROCH, Ph.D.
    In the second act of the musical West Side
 Story, a gang known  as the Jets gather and,
 having evaded  the cops  after a bloody fight
 with  a rival gang, sing a ditty to the  police
 officer on the beat about  the perils that face
 delinquents in court. They enact a scene in which
 the judge sends the delinquent to a psychiatrist.
 The  psychiatrist, after a successful snow job
 by the delinquent, declares magnanimously  that
 this here boy don't have to have his head shrunk
 at all. He is suffering from a social disease. He
 needs asocial worker.


Aspects OfAuthority                     -

In   Treatment

              JOHN   DE  LORIA
   As in the treatment of the nonoffender, an in-
creased awareness of self, a well as an increased
understanding of the world in which he lives, are
of first importance in the pyochiatric treatment of
the offender. The development of insight in these
areas will enable the offender to see how his feel-
ings motivated his behavior and to use his esergies
more  economically  and efficiently in behalf of
wholesome  personal and social growth. The liter-
sture regarding the offender is replete with illus-
trations of his  tendencies to act-out conflicts
impulsively, to seek  immediate  satisfaction of
needs and desires, to evade responsibility and to
avoid  close, enduring relationships with other
persons.
   The  primary  aims  of psychiatric treatment
are also shared by  probation, which  attempts,
through  social casework principles, to re-orient
and  re-educate the offender, so that he can har-
monine his needs and desires with the requirements
of social living, thereby avoiding conflict and/or
difficulty isr the ommnmity. l-isiregentlyfr er     -
sary  in asisting the offender to regain his normal
status in sociery, to re-interpret the meaning and
value of authority to him, so that he will learn
to  modify characteristic, and undesirable, ways
of reacting to it-directly or indirectly.
    When  psychiatric or social casework treatment
 of the offender is being considered within the
 framework  of an  authoritative setting such as
 probation, it must be kept in mind that the pro-
 bation agency is part of society's system of organ-
 ized social  control. The   therapist, whether
 psychiatrist or social worker, is not only concerned
 with understanding and modifying  behavior, but
 with assisting in its management and control. The
 protection and  safety of the community   takes
 precedence over  individualied treatment  plans
 and goals. The  offender's continuing freedom is


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